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SSL SK SHIP# 232688724 1111111111111111111111111111111111111 <br /> Please print or 0 0 7 7 7 0 1 6 2 S K S <br /> type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I 1.Generator ID Number CgR000039370 2.Page 1 of 3.EmeW ff R%oge L!"� 4.Manifest Tracking Number <br /> WASTE MANIFEST t 6�G� 1007770162 SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(8 different than mailing address) <br /> Escalon F'reaier Brands Inc. <br /> 1905 Mchenry Ave <br /> ESCALON CA 95320-0000 <br /> Generators Phone: 209-552-6051 <br /> 6.T'9WEf90-T !tR SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.TTE'E erg Com Name U.S.EPA ID Number <br /> CLEAN H�RYBORS ENV SVC INC, MAD039322250 <br /> 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 122533 SE CARPENTER. DR <br /> CLACKAMAS , OR 97015-8988 <br /> 503-788-4516 DRQ000025197 <br /> Facility's Rhona: <br /> ga 9b.U.S.DOT Descnptlon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Link 73.Waste Codes <br /> HM and Padding Gmup(if any)) No. Type Quantity WtNd. <br /> NON-RCRA HAZARDOUS WASTE SOLID P.M P 223 <br /> o (DRAINED/UNDRAINED USED bIL FILTERS) <br /> a <br /> W � i aso <br /> = 2 <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:TPO 84: i•c' "' ES1201' <br /> to <br /> 24H EMERGENCY#800-468-1750-CH/SK/TFI-Contract retained by gane• atr,r co- . «; s a. er;cy ,:uthori y <br /> on initial transporter to add or substitute additional trans Drters on ~eneraor' s behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeled/placarded,and are in alf respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I carify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. <br /> I oe"that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)if I am a small quantity generator)is true. <br /> GeneratorslOffemrs Pnntedrryped Name �2 Signature Month Day Year <br /> Buil' til lu <br /> 16.International Shipments <br /> r ❑Import to U.S. Ell from U.S. ort of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAcknoWedgment of Receipt of Matenals <br /> 1- Twiporter 1 Pnnted/TyWd ame Sgnawre Month Day Year <br /> a 1�4v1�1. �c;y14- to a$ Rix <br /> QTran Pnntedrfyped Name Month Da Year <br /> I Y <br /> } 18.Discrepancy <br /> l8a.Discrepancy Indication Space ❑ Quan <br /> lily Ll Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> Z5 <br /> LL Fadlitys Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2, <br /> 141 1 <br /> 20.Designated Facili Owner or Operator Certifimbon of receipt of hazardous materials covered by the manifest except noted in m i <br /> IIII' Printed/Typed Name Signature M nth Day Year <br /> n ti� <br /> EP i Fq'% 700.622 LR7ei_12-1�4riouseditions are obsolete. DE NATED FACILITY TO ERA'S a-M4TFEST SYSTEM <br />